Aburahma A F
Vascular Section, Charleston Area Medical Center, USA.
W V Med J. 1996 Sep-Oct;92(5):260-4.
Paradoxical embolism is defined as the passage of any material from the venous circulation into the systemic arterial tree via an abnormal communication which is accompanied by a right-to-left shunt. Although there are fewer than 40 reported cases, its incidence is probably much more frequent. This article describes our experiences treating six patients at Charleston Area Medical Center whose diagnosis of paradoxical emboli was based on the presence of Johnson's triad: (1) Venous thrombosis with/without pulmonary embolism, (2) An intracardiac defect with right-to-left shunting; and (3) Arterial embolism without a corresponding source in the left heart or proximal arterial tree. We conclude that paradoxical embolism should be considered in all patients with an unknown source of emboli, particularly young patients. If conventional M + 2D echocardiography and peripheral angiography are inconclusive, further work-up should be performed with contrast saline echocardiography, transesophageal echocardiography, lung scan, and peripheral venous imaging.
反常栓塞的定义为任何物质经伴有右向左分流的异常通道从静脉循环进入体循环动脉系统。尽管报道的病例少于40例，但其实际发生率可能更高。本文描述了我们在查尔斯顿地区医疗中心治疗6例患者的经验，这些患者反常栓塞的诊断基于约翰逊三联征：（1）伴有或不伴有肺栓塞的静脉血栓形成；（2）伴有右向左分流的心内缺损；（3）在左心或近端动脉系统无相应来源的动脉栓塞。我们得出结论，对于所有不明来源栓塞的患者，尤其是年轻患者，均应考虑反常栓塞。如果传统的M + 2D超声心动图和外周血管造影检查结果不明确，则应进一步进行对比盐水超声心动图、经食管超声心动图、肺部扫描和外周静脉成像检查。
